1. Sports Medicine II
And the Lower Leg
Foot
Mrs. Marr

2. THE 4 BONES OF THE ANKLE JOINT
FIBULA
TIBIA
TALUS
CALCANEUS

3. ANKLE LIGAMENTS – MEDIAL
Deltoid Ligament Complex
4 ligaments
Broad
Flat
Overlapping
= STRONG! D A C B

4. ANKLE LIGAMENTS - LATERAL
Lateral Collateral Ligaments
ATF
Anterior
From Talus to Fibula
Weakest of 3 ligaments
PTF
Posterior
Strongest/Deepest of 3 ligaments CF
From Calcaneus to Fibula
Largest; Strong and Cord-like

5. ANKLE MUSCLES: ANTERIOR SIDE
TIBIALIS ANTERIOR
Muscle top of Tibia
Tendon crosses over Ankle Talus
Attaches at the base of the 1st foot bone
Cross over at joint allows for multiple motions
Major Motion:
Dorsiflexion of the ankle joint
Inversion of the foot
Prevents the forefoot slapping AND scrapping the ground

6. ANKLE MUSCLES: LATERAL SIDE
PERONEAL GROUP
3 muscles (peroneus brevis/longus/tertius)
Muscle group top of Fibula
Peroneal tendon hooks around the back of Lateral Malleolus
Insertion of Peroneal Tendon is at the base of the 5th foot bone
Major Motion:
Eversion of the the Ankle

7. ANKLE MUSCLES: POSTERIOR
GASTROCNEMIUS
Muscle starts on distal femur
1 muscle with two points of origin
Achilles Tendon is other attachment
Crosses two joints
Major Motion:
the Ankle
ACHILLES TENDON
Large Tendon/Cord from Gastroc.
Inserts firmly at Calcaneus
Largest, Strongest Tendon in Body
Combination of Gastroc and Soleus Tendons

8. Compartments of the Leg
Anterior
Lateral (peroneal)
Deep posterior
Superficial posterior

10. Anterior Compartment Musculature
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Peroneus tertius
anterior tibialis, ext. hallucis longus, extensor digitorum longus, peroneus tertius, deep peroneal nerve and anterior tibial blood vessels. Muscles originate on the proximal 2/3 tibia and fibula, and insert on the bones of the foot.

11. Tibialis Anterior DF and inversion O: lateral tibial condyle and shaft
I: medial/plantar 1st cuneiform and metatarsal
N: deep peroneal

12. Extensor Digitorum Longus
Extension of 2nd-5th MP joints, assists with eversion and DF
O: lateral tibial condyle, proximal ¾ of anterior fibula
I: via 4 tendons into distal phalanges of 2nd-5th toes
N: deep peroneal

13. Extensor Hallucis Longus
Extension of 1st MP and IP joints
O: middle 2/3 of anterior fibula
I: base of distal 1st phalanx
N: deep peroneal

14. Peroneus Tertius Eversion of foot, assists in PF
O: distal 1/3 of anterior fibula
I: dorsal base of 5th metatarsal
N: deep peroneal

15. Lateral Compartment Musculature
Peroneus longus
Peroneus brevis
peroneus brevis, peroneus longus, peroneal artery, superficial peroneal nerve. Muscles originate on the fibula for the most part and insert on the plantar surface of the foot.

16. Peroneus Longus Eversion of the foot, assists with PF
O: lateral tibial condyle, fibular head, upper 2/3 of lateral fibula
I: lateral base of 1st metatarsal, lateral and dorsal aspect of 1st cuneiform
N: superficial peroneal

17. Peroneus Brevis Eversion of the foot, assists with PF
O: distal 2/3 of lateral fibula
I: styloid process at base of 5th metatarsal
N: superficial peroneal

18. Superficial Posterior Compartment Muscles
Gastrocnemius
Soleus
Plantaris
gastroc, soleus, plantaris, popliteal artery, tibial nerve. Muscles originate on the femur and high on the tibia and insert into the calcaneus

19. Gastrocnemius Ankle PF, assists knee flexion
O: medial head – posterior medial femoral condyle, lateral head – posterior lateral femoral condyle
I: calcaneus via Achilles tendon
N: tibial

20. Soleus
Ankle PF
O: posterior fibular head, upper 1/3 of posterior fibular, soleal line on posterior tibial shaft, middle 1/3 of medial tibial border
I: calcaneus via Achilles tendon
N: tibial

21. Plantaris Ankle PF, assists knee flexion
O: distal supracondylar line of lateral femoral condyle, femoral popliteal surface
I: calcaneus via Achilles tendon
N: tibial

22. Deep Posterior Compartment Musculature
“Tom, Dick, AND Harry”
Tibialis posterior
Flexor Hallucis Longus
Flexor Digitorum Longus
flexor hallucis longus, flexor digitorum longus, tibialis posterior, tibial nerve, peroneal artery, post. tibial artery. These structures originate on the posterior proximal 2/3 of tibia, interosseous membrane and fibula

23. Tibialis Posterior Inversion of the foot, assists with PF
O: posterior/lateral tibia, upper 2/3 of medial fibula
I: navicular tuberosity, via slips into sustentaculum tali, cuneiforms, cuboid and bases of 2nd-4th metatarsals
N: tibial

24. Flexor Digitorum Longus
Flexion of 2nd-5th PIP/DIP/MP joints, assists with foot inversion and PF
O: posterior medial 2/3 of distal tibia
I: plantar surface of base of 2nd-5th distal phalanges
N: tibial

25. Flexor Hallucis Longus
Flexion of 1st IP joint, assists with flexion of 1st MP joint, foot inversion and PF
O: posterior/distal 2/3 of fibula
I: plantar surface of 1st proximal phalanx
N: tibial

26. Syndesmosis
Interosseous membrane (Syndesmosis) isn't a compartment but ligamentous sheathe that holds the tibia and the fibula together.

27. Nerves and Blood Vessels
Peroneal N.
Tibialis Anterior/ Posterior N.
Saphenous N.
Blood Vessels
Dorsal Pedal A.
Posterior Tibial A.
Greater/ Lesser Saphenous V.

28. Neuroanatomy Anterior compartment Lateral compartment
Deep branch of Peroneal nerve
Lateral compartment
Superficial branch of Peroneal nerve
Deep posterior compartment
Tibial nerve
Superficial posterior compartment

29. Deep Branch of Peroneal Nerve
Branches from common Peroneal nerve near fibular head
“Dives” into anterior compartment

30. Superficial Branch of Peroneal Nerve
Branches from common Peroneal nerve near fibular head
Stays superficial and lateral in lateral compartment

31. Tibial Nerve
Runs in fascial sheath between deep and superficial posterior compartments
Provides innervation to both, but not “in” either

32. Vascular Anatomy Anterior compartment Lateral compartment
Anterior tibial artery
Lateral compartment
Peroneal artery
Deep posterior compartment
Posterior tibial artery
Superficial posterior compartment

33. Anterior Tibial Artery
Traverses similar path to deep Peroneal nerve
Terminating as dorsal pedal artery

34. Peroneal Artery
Branches off of posterior tibial artery

35. Posterior Tibial Artery
Runs in fascial sheath between deep and superficial posterior compartments
Provides vascular supply to both, but not “in” either

36. Special Tests The Squeeze Test
check malleolus
Check tibia and fibula
May indicate FX
Feel for any abnormalities
Feeling for grinding or movement

37. Special Tests Anterior Drawer/Tilt
Anterior drawer tests should always be performed with the knee bent to eliminate the Achilles and Gastrocnemius muscles from providing any stability to the ankle.
A lateral talar tilt test can be conducted at the same time.

38. Anterior Drawer Test

39. Tilt Test

40. Special Tests Functional Tests
(Return to play)
a) walking - check gait
b) toe raises
1) both feet
2) one foot
c) jump and land on both feet and then on one foot